Health Care for Older Americans with Multiple Chronic Conditions: A Research Agenda
Susan L. Norris MD, MPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorKevin High MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorThomas M. Gill MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorSean Hennessy PharmD, PhD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorJean S. Kutner MD, MSPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorDavid B. Reuben MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorJürgen Unützer MD, MA, MPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorC. Seth Landefeld MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorSusan L. Norris MD, MPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorKevin High MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorThomas M. Gill MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorSean Hennessy PharmD, PhD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorJean S. Kutner MD, MSPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorDavid B. Reuben MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorJürgen Unützer MD, MA, MPH
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorC. Seth Landefeld MD
From the * Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon † Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina ‡ Department of Epidemiology and Investigative Medicine, School of Medicine, Yale University, New Haven, Connecticut § Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania ∥ Division of General Internal Medicine, University of Colorado at Denver Health Sciences Center, Denver, Colorado # Division of Geriatrics, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California ** Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, Washington †† Division of Geriatrics, University of California at San Francisco, San Francisco, California ‡‡ Geriatrics and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.
Search for more papers by this authorAbstract
In response to the substantial and increasing healthcare requirements of older adults with multiple chronic conditions and acknowledgment of major gaps in knowledge and funding, two expert meetings were convened to identify a research agenda addressing the needs of this population. Research priorities are to develop and evaluate more-effective models of health care, develop and evaluate management practices and organizational structures that lead to improved long-term care, develop and implement relevant and effective preventive health strategies, determine the most effective interventions in patients who have concurrent cognitive or emotional impairments, and determine how interventions during and after hospitalization affect the outcomes of hospitalized patients.
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